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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettvia.gov/permits <br /> (Blue au-Es%acft Er.21 Orzfgr Please) PROJECT SETE INFORMAT DON <br /> PROJECT SITE ADDRESS: 515 SE Everett Mail Way,Everett WA 98208 PROPERTY TAX#: <br /> LEGAL for new construction Short Platisubdivivon Lct No (aCPch copy of long Iegai description) <br /> �= -- -- s-_.,...��_ COR7TEQ(C4 BEL(F®IRfi'v9!':TB(�f11i -_ J- <br /> ;OWNER <br /> Chipotle Mexican Grill NAME: TENANT NAME(if Commercial): Chipotle Mexican Grill <br /> OWNER MAILING ADDRESS: STREET 1401 wynko pSt Suite 500 <br /> CITY Denver STATE <br /> 7lP 60202 <br /> OWNER PHONE: 760-695-2813 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY11A 11A uZ STATE Lip q$D <br /> CONTRACTOR PHONE: LU 5_(0 5 --16(1 CONTRACTOR EMAIL: l' <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OS SCJ <br /> PRIMARY CONTACT: ❑OWNER MtONTRACTOR ❑OTHER(Please Specify) <br /> iCONTACT NAME: CONTACT PHONE: 495-902- I�L <br /> C��1L CONTACT EMAIL• r'l�< C�s'T2 Ctt i! <br /> Existing Use of Building. Contract Price of Work:$ G <br /> Proposed Use of Building Heat Source: ❑Gas ❑Electric ❑Other__ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Family-#of Units: _ E Commercial ❑Industrial <br /> T pe of Proect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Sin ❑S rinkier ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if applicable): fJ f lL`�'J v NY I t` <br /> MIECHANECLL PER LE Z &PPLICT EOKI ��--PLUMBIN n PSBR• aCTf QIP[ BCG��BOB� — <br /> Type of Project:®New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of <br /> Fixtures Fixturestures Fixtures Fixtures List of Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg <br /> Forted Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater <br /> Other: <br /> Exhaust Fan <br /> Sink(Service/bar/Mopletc.) Other <br /> I <br /> aP[iBEWKLIE R I EUIPPBRESSOM, STi'STEWL <br /> Number of Heads <br /> ACKNOWLEDGEMENT.t have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> 8uMing Official before being authorized under any circumstance.t am Me owner.or I am authorized by the owner of this property to perform the work for which application is made. <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#) <br /> IIi:.Ff:.'-SN�l� <br /> Ow wrlAuthonzed Aqcnt Signature Date ;Revised,V?0,2016) <br />